Basic Information
| Provider Information | |||||||||
| NPI: | 1689905531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAWSON | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | ROCKWELL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 481 E 1950 N | ||||||||
| Address2: | |||||||||
| City: | NORTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844143015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013173809 | ||||||||
| FaxNumber: | 3854052614 | ||||||||
| Practice Location | |||||||||
| Address1: | 298 24TH ST STE 204 | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844011870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3854052533 | ||||||||
| FaxNumber: | 3854052533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2010 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW-1417 | CO | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 6720347-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 18173560 | 05 | CO | MEDICAID |